Active NPI
Bannester Lester Harbin Jr., MD
- Surgery Physician
- Rome, GA
National Provider Identifier
1346301652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 010184
- Practice address
- 1825 Martha Berry Blvd NW
Rome, GA 30165-1625 - Phone
- (706) 295-5331
- Fax
- (706) 236-6432
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 010184 | GA | Primary |
Addresses
Primary practice location
1825 Martha Berry Blvd NW
Rome, GA 30165-1625
Mailing address
1825 Martha Berry Blvd NW
Rome, GA 30165-1625
Phone (706) 295-5331
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000038673A | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277856000000",
"number": "1346301652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1825 MARTHA BERRY BLVD NW",
"city": "ROME",
"state": "GA",
"postal_code": "301651625",
"telephone_number": "706-295-5331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1825 MARTHA BERRY BLVD NW",
"city": "ROME",
"state": "GA",
"postal_code": "301651625",
"telephone_number": "706-295-5331",
"fax_number": "706-236-6432"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARBIN",
"first_name": "BANNESTER",
"middle_name": "LESTER",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2010-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "GA",
"license": "010184",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000038673A",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rome, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.